Provider Demographics
NPI:1588809792
Name:NORTHEAST ARKANSAS CLINIC, P.A.
Entity Type:Organization
Organization Name:NORTHEAST ARKANSAS CLINIC, P.A.
Other - Org Name:NEA CLINIC-CENTER FOR SLEEP DISORDERS
Other - Org Type:Other Name
Authorized Official - Title/Position:COO
Authorized Official - Prefix:MR
Authorized Official - First Name:DARRELL
Authorized Official - Middle Name:
Authorized Official - Last Name:KING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:870-934-5140
Mailing Address - Street 1:PO BOX 1960
Mailing Address - Street 2:
Mailing Address - City:JONESBORO
Mailing Address - State:AR
Mailing Address - Zip Code:72403-1960
Mailing Address - Country:US
Mailing Address - Phone:870-934-5140
Mailing Address - Fax:870-932-3608
Practice Address - Street 1:1118 WINDOVER RD
Practice Address - Street 2:
Practice Address - City:JONESBORO
Practice Address - State:AR
Practice Address - Zip Code:72401-6038
Practice Address - Country:US
Practice Address - Phone:870-336-4145
Practice Address - Fax:870-336-4148
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NORTHEAST ARKANSAS CLINIC, P.A.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-12-03
Last Update Date:2008-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS1200XAmbulatory Health Care FacilitiesClinic/CenterSleep Disorder Diagnostic